| NPI | 1528665841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1000555) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY F02200514) |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2022-09-28 |