| NPI | 1780075473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR A004574) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP127398) |
| Enumeration Date | 2015-02-17 |
| Last Update Date | 2024-05-24 |