| NPI | 1023068012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP017111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP114354) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2022-07-21 |