| NPI | 1528720646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner Pediatrics (Licence: UT 12445460-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 12445460-3102) |
| 163W00000X Registered Nurse (Licence: TN 248472) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: UT 12445460-4405) | |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2021-10-25 |