| NPI | 1073870838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 521847) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 522212) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2012-04-18 |