| NPI | 1174089718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 289574) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 71452) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP140311) | |
| Enumeration Date | 2019-02-19 |
| Last Update Date | 2025-01-07 |