| NPI | 1861899304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 19436) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 3287) |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 845001) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 24182631) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 3016538) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 205280) | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 25533) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71011875A) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 10167) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704380806) | |
| Enumeration Date | 2014-11-27 |
| Last Update Date | 2021-11-19 |