| NPI | 1992249437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 8306305-8900) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: UT 8306305-3102) |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 8306305-4405) | |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2017-04-25 |