| NPI | 1649789165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 22736) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 22736) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2026-05-11 |