| NPI | 1811549306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: KY 3016250) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KY 30126250) |
| 363L00000X Nurse Practitioner (Licence: IN 71011063A) | |
| 363LF0000X Nurse Practitioner Family (Licence: IN 71011063A) | |
| 363LF0000X Nurse Practitioner Family (Licence: AZ 228482) | |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2022-09-08 |