| NPI | 1619683406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1109154) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 923959) |
| Enumeration Date | 2023-01-25 |
| Last Update Date | 2023-02-06 |