| NPI | 1710437124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL APRN9490867) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP134199) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9490867) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CT 9221) | |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2024-03-26 |