| NPI | 1669075388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1016686) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1016686) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2021-09-09 |