| NPI | 1336849561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10806270-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 10806270-8900) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-03-07 |