| NPI | 1083890586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 790095) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NM CNP-01986) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2012-11-26 |