| NPI | 1205355211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP028076) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135106) |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2023-09-11 |