| NPI | 1083071468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP130118) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 803586) |
| 163W00000X Registered Nurse (Licence: TX 803586) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2023-12-21 |