| NPI | 1407259948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-194586) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 864513) |
| Enumeration Date | 2014-09-29 |
| Last Update Date | 2023-07-20 |