| NPI | 1720429491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 7013173-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT 7013173-4405) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: UT 7013173-4405) | |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2021-09-14 |