| NPI | 1497050306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP142679) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MS R790626) |
| Enumeration Date | 2011-01-24 |
| Last Update Date | 2021-01-06 |