| NPI | 1497329627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 66685) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1038058) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2022-03-24 |