| NPI | 1871940593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 246391) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130967) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2021-07-13 |