| NPI | 1922435759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704426780) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IA A169406) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 78417) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 855867) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 307138) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 3-001839) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 4023144) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 36402) | |
| 363LF0000X Nurse Practitioner, Family (Licence: LA 236042) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 800688) | |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2025-04-10 |