| NPI | 1730781451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM 80531) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 11032336-4405) |
| 363L00000X Nurse Practitioner (Licence: TX 1093694) | |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2024-12-31 |