| NPI | 1679827604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 2012005750) |
| Additional Taxonomies | 363LX0106X Nurse Practitioner Occupational Health (Licence: TX AP122460) |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2023-09-20 |