| NPI | 1831623990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R47976) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP09859) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP133513) | |
| Enumeration Date | 2017-04-16 |
| Last Update Date | 2020-09-24 |