| NPI | 1780236109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 9523151-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: UT 9523151-4405) |
| 163W00000X Registered Nurse (Licence: UT 9523151-3102) | |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: UT 9523151-4405) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: UT 9523151-4405) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2022-05-24 |