| NPI | 1609833250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-648A) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 681333) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2015-11-16 |