| NPI | 1851671671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 7999068-4405) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: UT 79990683101) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2021-11-10 |