| NPI | 1205344009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 23296) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137245) |
| Enumeration Date | 2018-01-14 |
| Last Update Date | 2019-12-03 |