| NPI | 1295374254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8152388-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8152388-3102) |
| Enumeration Date | 2019-12-22 |
| Last Update Date | 2023-01-12 |