| NPI | 1447759642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP136419) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO C-APN.0101691-C-NP) |
| Enumeration Date | 2018-02-03 |
| Last Update Date | 2024-08-16 |