| NPI | 1689458606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 10841878-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 10841878-4405) |
| Enumeration Date | 2023-08-21 |
| Last Update Date | 2024-03-20 |