| NPI | 1952880122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 8753-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 834537) |
| 363L00000X Nurse Practitioner (Licence: WI 8753-33) | |
| 363L00000X Nurse Practitioner (Licence: IL 277001302) | |
| 363L00000X Nurse Practitioner (Licence: AZ 245123) | |
| 363L00000X Nurse Practitioner (Licence: CO 0996403) | |
| 363L00000X Nurse Practitioner (Licence: HI 3344) | |
| 363L00000X Nurse Practitioner (Licence: TX 1019756) | |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2024-05-17 |