| NPI | 1346799723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OK 94357) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP131704) |
| 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-127828) | |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2017-11-02 |