| NPI | 1225861693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 10357985-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 10357985-4405) |
| Enumeration Date | 2024-08-21 |
| Last Update Date | 2024-11-07 |