| NPI | 1770078842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8334395-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 8334395) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2022-06-09 |