| NPI | 1043984008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1044866) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1044866) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1044866) | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2021-09-03 |