| NPI | 1669141396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1098294) |
| Additional Taxonomies | 163WE0003X Registered Nurse Emergency (Licence: TX 895346) |
| Enumeration Date | 2021-09-07 |
| Last Update Date | 2024-09-18 |