| NPI | 1609491059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1075233) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 988407) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2022-06-07 |