| NPI | 1669615316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 665638) |
| Additional Taxonomies | 364SC1501X Clinical Nurse Specialist, Community Health/Public Health (Licence: TX 665638) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2009-06-28 |