| NPI | 1336162031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MT NUR-APRN-LIC-127234) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AK 220055) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP111762) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2024-08-01 |