| NPI | 1790092807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 9105677-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9264185) |
| Enumeration Date | 2010-09-10 |
| Last Update Date | 2021-11-17 |