| NPI | 1114118221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP00942) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 638070) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2023-09-15 |