| NPI | 1578249314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 8013466-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 8013466-8900) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 8013466-4405) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 8013466-4405) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 8013466-8900) | |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2024-09-13 |