| NPI | 1609444603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 12944235-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7376490-3102) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2022-12-11 |