| NPI | 1972070316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R213670) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R213670) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: FL TPAN3792) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024194474) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1228096) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ 333131) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: OH APRN.CNP.0035594) | |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2026-03-13 |