| NPI | 1306534458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 11475617-4405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11475617-4408) |
| 207Q00000X Family Medicine (Licence: UT 11475617-3102) | |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2024-05-31 |