| NPI | 1811385461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY F345730) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F309619) |
| 363L00000X Nurse Practitioner (Licence: IA H142277) | |
| 363L00000X Nurse Practitioner (Licence: MD AC001545) | |
| 363L00000X Nurse Practitioner (Licence: VA 0024172583) | |
| 363L00000X Nurse Practitioner (Licence: MO 2014042985) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2018006271) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A154211) | |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2020-11-13 |