| NPI | 1144388034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP110847) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.12362) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 110847) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-128099) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2017-11-30 |