| NPI | 1427099530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 658019) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 118322) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2023-05-08 |