| NPI | 1760848204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 20898) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024173331) |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71014917A) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5017076) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0035716) | |
| 163W00000X Registered Nurse (Licence: TN 198628) | |
| 163W00000X Registered Nurse (Licence: IL 41.564483) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209.030704) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2024004887) | |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2025-02-19 |