| NPI | 1043479462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 704263) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 704263) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2015-12-28 |