| NPI | 1386223055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8535237-4405) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 163W00000X Registered Nurse (Licence: UT 8535237-3102) | |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-05-07 |