| NPI | 1073872909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 8211624-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 8211624-4405) |
| Enumeration Date | 2012-05-12 |
| Last Update Date | 2025-12-18 |