| NPI | 1841661543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137731) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.013185) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2023-02-01 |