| NPI | 1346376977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 644845) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 2006003605-22) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2009-03-04 |