| NPI | 1609268317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8927878-8900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 8927878-3102) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2021-08-10 |