| NPI | 1548657802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 229136) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP127755) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2021-07-07 |