| NPI | 1144912932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1125554) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 205873) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-06-12 |