| NPI | 1245625565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11018318) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127635) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2022-08-01 |