| NPI | 1437228624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 772582) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: CA 564692) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2017-06-09 |