| NPI | 1326342965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP120113) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 753658) |
| Enumeration Date | 2010-12-22 |
| Last Update Date | 2018-07-05 |