| NPI | 1730713983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1110938) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 979239) |
| Enumeration Date | 2020-02-26 |
| Last Update Date | 2023-06-26 |