| NPI | 1871074955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138276) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95009960) |
| 363LF0000X Nurse Practitioner, Family (Licence: MA RN2337282) | |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2023-04-11 |