| NPI | 1366463630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP1033278) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY F334175-1) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2024-09-10 |