| NPI | 1457083214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1086272) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 71014617A) |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2023-12-07 |