| NPI | 1982185054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7245822-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 7245822-3102) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2020-07-14 |