| NPI | 1043966245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1066266) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 979882) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2022-02-25 |