| NPI | 1528087590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OK R0069302) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 668386) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2008-06-11 |