| NPI | 1407370844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 8262230-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8262230-3102) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 2017010996) | |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2023-07-27 |