| NPI | 1487849188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1011822) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 922214) |
| 207R00000X Internal Medicine (Licence: GA TL2791) | |
| Enumeration Date | 2007-09-06 |
| Last Update Date | 2020-09-08 |