| NPI | 1700352317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1000561) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9456188) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 131569) | |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2021-03-04 |