| NPI | 1891133369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: LA 227309) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60627765) |
| 363LF0000X Nurse Practitioner Family (Licence: TN APN0000017603) | |
| 363LF0000X Nurse Practitioner Family (Licence: OR 201906750-NP-PP) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: AK 116687) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2022-11-07 |