| NPI | 1295255701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 5130849-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT F05170659) |
| Enumeration Date | 2017-06-26 |
| Last Update Date | 2022-10-24 |