| NPI | 1366941650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1061932) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP9407120) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9407120) | |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2024-01-02 |