| NPI | 1487927711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 662508) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: AR A03644) |
| 363LF0000X Nurse Practitioner Family (Licence: OK M0115555) | |
| Enumeration Date | 2012-02-16 |
| Last Update Date | 2022-10-24 |