| NPI | 1508844861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: HI 675) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 583059) |
| 163WP2201X Registered Nurse, Ambulatory Care (Licence: HI 45098) | |
| 164X00000X Licensed Vocational Nurse (Licence: TX 69774) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2007-07-08 |