| NPI | 1215339957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 10329549-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ID N-45137) |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2023-06-08 |