| NPI | 1720396633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 805930) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 81255) |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2015-07-13 |