| NPI | 1467152389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1138338) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 942839) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2024-07-29 |