| NPI | 1578073250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9571169-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 9571169-4405) |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2023-07-14 |