| NPI | 1306013305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 12510) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145757) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2020-06-11 |