| NPI | 1316792443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 509589) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1165889) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-06-12 |