| NPI | 1548686231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 746329) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP125286) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2024-09-17 |