| NPI | 1518076140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 662034) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: KY 3007955) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-03-23 |