| NPI | 1326413345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 366253-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 366253-3105) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2022-03-19 |