| NPI | 1942591441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 5581789-4405) |
| Additional Taxonomies | 247000000X Technician, Health Information |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2023-06-08 |