| NPI | 1962070102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 10676959-4405) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: UT 10676959-3102) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2022-08-26 |