| NPI | 1922687839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1034117) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 915910) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2021-04-07 |