| NPI | 1407466410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1007822) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 816398) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2022-09-13 |