| NPI | 1235476870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 745657) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 745657) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2024-03-06 |