| NPI | 1376702902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 688152) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 688152) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2016-02-12 |