| NPI | 1508598079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9641683-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 9641683-4405) |
| 163W00000X Registered Nurse (Licence: UT 9641683-3102) | |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2024-03-04 |