| NPI | 1386277028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1002880) |
| Additional Taxonomies | 163WM0705X Registered Nurse Medical-Surgical (Licence: TX 893922) |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2023-06-15 |