| NPI | 1144623455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9462949) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9462949) |
| 163WA2000X Registered Nurse, Administrator (Licence: TX 785488) | |
| 363L00000X Nurse Practitioner (Licence: TX AP126856) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP126856) | |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2019-05-25 |