| NPI | 1528218336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP117122) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 653546) |
| Enumeration Date | 2008-09-29 |
| Last Update Date | 2022-08-22 |