| NPI | 1639517113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP124105) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 741486) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2020-11-05 |