| NPI | 1821787730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP027875) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA 646878) |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F354602-01) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD RN264698) | |
| 363LF0000X Nurse Practitioner, Family (Licence: DC NP500014235) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN324699) | |
| Enumeration Date | 2023-05-05 |
| Last Update Date | 2024-08-19 |