| NPI | 1871164798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO APN1001433NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11030808) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1046231) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY F359423-01) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 90028) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 243741) | |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP032410) | |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 14282604-4405) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024197768) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 228413) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA APTP.N3.70145018) | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2026-07-10 |