| NPI | 1639466659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 728443) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA RN087962-AP04144) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2011-06-29 |