| NPI | 1275268328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1077108) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11020920) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2024-05-08 |