| NPI | 1699242842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139763) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 816201) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60909284) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP60909284) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 816201) | |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2023-10-13 |