| NPI | 1457750713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NY 339042) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126511) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2018-04-09 |