| NPI | 1619238995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 667561) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX RN667561) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2012-10-16 |