| NPI | 1689376352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7341282-4405) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 7341282-4405) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2024-10-01 |