| NPI | 1427727494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1055634) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX F09210496) |
| Enumeration Date | 2021-09-12 |
| Last Update Date | 2022-01-25 |