| NPI | 1841768322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 4006776) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0038275) |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209021123) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704371721) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 35505) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL F09180994) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71008643B) | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2025-05-01 |