| NPI | 1215561642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11017089) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR 123641) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1050304) | |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2023-03-08 |