| NPI | 1457788572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 7165938-4405) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: UT 7165938-3102) |
| Enumeration Date | 2013-10-03 |
| Last Update Date | 2025-08-05 |