| NPI | 1821548660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1008467) |
| Additional Taxonomies | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: MO 2016035656) |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2020-11-09 |