| NPI | 1922854165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: AR 223861) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 1154718) |
| Enumeration Date | 2024-04-29 |
| Last Update Date | 2024-09-16 |