| NPI | 1982137501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 65936) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NV 829203) |
| 363L00000X Nurse Practitioner (Licence: WA AP61050684) | |
| 363L00000X Nurse Practitioner (Licence: CO APN.00995646-NP) | |
| 363L00000X Nurse Practitioner (Licence: OH APRN.CNP.0027848) | |
| 363L00000X Nurse Practitioner (Licence: OR 201702486NP-PP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201702486NP-PP) | |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2020-12-07 |