| NPI | 1265148910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11024120) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1112626) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 74278) | |
| Enumeration Date | 2023-01-26 |
| Last Update Date | 2023-09-28 |