| NPI | 1568716454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-171804) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 847811) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 847811) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4733) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP124560) | |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2020-07-10 |