| NPI | 1275121733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 1021162) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1021162) |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2022-08-18 |