| NPI | 1194740167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP00794) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 500800) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2013-10-21 |