| NPI | 1386183838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 6497915-4405) |
| Additional Taxonomies | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: UT 6497915-4405) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 6497915-4405) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2020-02-10 |