| NPI | 1518419936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX A131670) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.014601) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2016-11-02 |