| NPI | 1518610641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10376632-4405) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10376632-4405) |
| Enumeration Date | 2022-01-29 |
| Last Update Date | 2022-06-30 |