| NPI | 1205452919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1045300) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 789334) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2024-02-19 |