| NPI | 1366637852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 669825) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX 669825) |
| Enumeration Date | 2007-09-08 |
| Last Update Date | 2015-08-21 |