| NPI | 1730201245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 350245-4405) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: UT 350245-8900) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2022-12-29 |