| NPI | 1124442199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1028685) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5387) |
| Enumeration Date | 2014-02-12 |
| Last Update Date | 2024-11-25 |