| NPI | 1437903648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 10806171-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 10806171-3102) |
| Enumeration Date | 2024-04-15 |
| Last Update Date | 2024-08-29 |