| NPI | 1548515935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 4852218-8900) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-01992) |
| Enumeration Date | 2012-07-21 |
| Last Update Date | 2015-06-18 |