| NPI | 1902303225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN232819) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN232819) |
| 363LF0000X Nurse Practitioner Family (Licence: CO C-APN.0101857-C-NP) | |
| 363LF0000X Nurse Practitioner Family (Licence: AZ 305376) | |
| 363LF0000X Nurse Practitioner Family (Licence: WA N361555210) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-05-22 |