| NPI | 1497793707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: UT 192744-4405-20140124) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 192744-4405) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2019-04-22 |