| NPI | 1982378543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10222776-4405) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 10222776-4405) |
| Enumeration Date | 2021-08-05 |
| Last Update Date | 2022-05-17 |