| NPI | 1215438072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1072819) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 721013) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2022-03-14 |