| NPI | 1417987801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP112042) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 547441) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2024-01-02 |