| NPI | 1801960463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9465254) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: HI APRN1309) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 264640-1806) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 07904246N1) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9178533) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2018-04-23 |