| NPI | 1609452960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 9784958-4405) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 9784958-8900) |
| Enumeration Date | 2021-03-18 |
| Last Update Date | 2024-05-13 |