| NPI | 1285033142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP125956) |
| Additional Taxonomies | 363LC1500X Nurse Practitioner Community Health (Licence: TX AP125956) |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP125956) | |
| Enumeration Date | 2014-08-17 |
| Last Update Date | 2014-08-17 |