| NPI | 1336632215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9592039-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 9592039-3102) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2023-12-19 |