| NPI | 1912172305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 13427) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201709334NP-PP-Acute) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 13427) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 200917) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AK APN1324) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN 101543) | |
| 363LF0000X Nurse Practitioner, Family (Licence: ND R34723) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 5502) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201708800NP-PP) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2021-01-29 |