| NPI | 1932608882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP137587) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN260517) |
| 363L00000X Nurse Practitioner (Licence: GA RN260517) | |
| 363L00000X Nurse Practitioner (Licence: AZ 246032) | |
| 363L00000X Nurse Practitioner (Licence: OH IAPRN.CNP.0000003) | |
| 363L00000X Nurse Practitioner (Licence: NJ NJDCATEMP-030051) | |
| 363L00000X Nurse Practitioner (Licence: IN 71010530A) | |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2026-01-26 |