| NPI | 1811537483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1108427) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: TX 80926) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2023-01-24 |