| NPI | 1558961854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7658791-8900) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: UT 7658791-3102) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2024-09-04 |