| NPI | 1801360318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 343949) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OR 10007611) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1098789) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 295819) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11023651) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5019513) | |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-04-12 |