| NPI | 1588615611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 735301) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NC 162674) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2014-01-11 |