| NPI | 1922367044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 20180868NP-PP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 816544) |
| Enumeration Date | 2012-05-09 |
| Last Update Date | 2021-10-28 |