| NPI | 1477094993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 7593) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX F03170378) |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2023-10-31 |