| NPI | 1346939626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 913785) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1111163) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2023-06-29 |