| NPI | 1740980713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 7986448-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7986448-3102) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2023-04-14 |