| NPI | 1275924417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP127410) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AK 125601) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2022-07-30 |