| NPI | 1205039567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: TX AP117348) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: TX 677765) |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: TX 677765) | |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: TX AP117348) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2017-11-28 |