| NPI | 1275091480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1015741) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AK 143855) |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2020-12-22 |