| NPI | 1932778917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 218673) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R50316) |
| 363LF0000X Nurse Practitioner, Family (Licence: HI APRN-3126) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1088207) | |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-06-05 |