| NPI | 1902298706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP09297) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127300) |
| Enumeration Date | 2015-03-03 |
| Last Update Date | 2023-01-31 |