| NPI | 1801283841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MD AC004166) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127995) |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2022-07-20 |