| NPI | 1831843044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1017594) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1017594) |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-05-12 |