| NPI | 1578040465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 7062265-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 7062265-4405) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2025-01-23 |