| NPI | 1609538057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10846140-8900) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 10846140-3102) |
| 363L00000X Nurse Practitioner (Licence: UT 10846140-4405) | |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2023-07-20 |