| NPI | 1336117522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK R0055785) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP132700) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2024-02-13 |