| NPI | 1184291726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1041567) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: TX 1041567) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-07-13 |