| NPI | 1174602569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1168479) |
| Additional Taxonomies | 163WM0705X Registered Nurse, Medical-Surgical (Licence: NM R39751) |
| Enumeration Date | 2006-11-04 |
| Last Update Date | 2024-09-27 |