| NPI | 1477208056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1072801) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 773092) |
| Enumeration Date | 2022-02-13 |
| Last Update Date | 2022-05-26 |