| NPI | 1215489513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11001681) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132452) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2019-06-20 |