| NPI | 1659943322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1047212) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: TX 1047212) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2021-09-09 |