| NPI | 1144608050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 287581-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 287581-4408) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2024-04-15 |