| NPI | 1235213083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-073507) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 703720) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2016-03-04 |