| NPI | 1750935821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 5016079) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP142126) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2022-07-26 |