| NPI | 1215448501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1088484) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: WI 8073-33) |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2023-03-16 |