| NPI | 1982309274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 13337289-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: UT 10316494-3102) |
| Enumeration Date | 2023-04-04 |
| Last Update Date | 2023-04-11 |