| NPI | 1851014807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-133967) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 308858) |
| 363L00000X Nurse Practitioner (Licence: CO C-APN.0102272-C-NP) | |
| 363L00000X Nurse Practitioner (Licence: CO C-RXN.0101549-C-NP) | |
| 363L00000X Nurse Practitioner (Licence: WA AP61559078) | |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2024-06-15 |