| NPI | 1740296318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP2978) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 679032) |
| 363L00000X Nurse Practitioner (Licence: NM CNP-01887) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2014-01-09 |