| NPI | 1689683682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 35332) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: OH COA.08853-NP) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP118989) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP118989) | |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2024-05-19 |