| NPI | 1902157357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11005304) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001671) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4674) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP124941) | |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2020-08-19 |