| NPI | 1083227516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1088094) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 309926) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2023-01-26 |