| NPI | 1811474935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9345630) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8966-33) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 71770) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA NP95023727) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9345630) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA NP95023727) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 71770) | |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2023-03-03 |