| NPI | 1992787824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP000487) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2025051325) |
| 207Q00000X Family Medicine (Licence: AZ 329373) | |
| 207Q00000X Family Medicine (Licence: MN 13255) | |
| 207Q00000X Family Medicine (Licence: MT APRN-278341) | |
| 207Q00000X Family Medicine (Licence: AK 244156) | |
| 207Q00000X Family Medicine (Licence: IL 277005063) | |
| 207Q00000X Family Medicine (Licence: HI APRN-5415) | |
| 207Q00000X Family Medicine (Licence: WA AP70034977) | |
| 207Q00000X Family Medicine (Licence: UT 14246859-4405) | |
| 207Q00000X Family Medicine (Licence: OR 10049420) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2026-02-01 |