| NPI | 1902317837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8301709-4405) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 8301709-4405) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2018-04-26 |