| NPI | 1760092340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: OK 211116) |
| Additional Taxonomies | 333300000X Emergency Response System Companies |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA GAA-NP001276) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: DC NP500008018) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11024684) | |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2023-04-13 |