| NPI | 1962133686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: UT 13523469-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9552971) |
| 363L00000X Nurse Practitioner (Licence: FL 9552971) | |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2024-04-23 |