| NPI | 1487305868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 9629878-4405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 9629878-4405) |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2024-05-02 |