| NPI | 1881294775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11009738) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 36524) |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 3-001657) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0033374) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1181313) | |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2025-04-02 |