| NPI | 1942941307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP141282) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 805730) |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2022-06-28 |