| NPI | 1396850871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 630161) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 630161) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2020-02-24 |