| NPI | 1043741176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6914314-4405) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant (Licence: UT 2017-PCA-UT000567) |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2023-12-18 |