| NPI | 1699823179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 524745) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP110189) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2020-09-17 |