| NPI | 1083616080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 506033) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR A01143) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2007-07-08 |