| NPI | 1558796391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 5531793-4405) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 5531793-8900) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2016-01-14 |