| NPI | 1003380262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1004829) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0994348-NP) |
| Enumeration Date | 2019-01-21 |
| Last Update Date | 2023-11-08 |