| NPI | 1427606763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP142365) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AZ 289326) |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2024-05-08 |