| NPI | 1194475384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11018930) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F03220718) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2023-03-16 |