| NPI | 1881240919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 11501225-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 230938) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2026-04-03 |