| NPI | 1629551247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 4868927-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 4868927-3102) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2019-03-07 |