| NPI | 1366521833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 287570-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 287570-4405) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2022-01-28 |