| NPI | 1003671272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10469779-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 10469779-8900) |
| Enumeration Date | 2024-02-16 |
| Last Update Date | 2024-04-30 |