| NPI | 1508183138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NM CNP-01957) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 677019) |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2016-12-01 |