| NPI | 1447696133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 6998855-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 6998855-8900) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2013-06-20 |