| NPI | 1124396957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP121268) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL APRN11006780) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN204643) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11006780) | |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2023-08-01 |