| NPI | 1215527775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9194804-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 9194808-8900) |
| Enumeration Date | 2021-01-19 |
| Last Update Date | 2021-01-20 |