| NPI | 1740934488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: UT 8298342-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 8298342-4405) |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2023-10-04 |