| NPI | 1538808746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7974656-4405) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner, Community Health (Licence: UT 7974656-4405) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: UT 7974656-3102) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 7974656-4405) | |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2023-11-14 |