| NPI | 1740507029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN152026) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 809428) |
| Enumeration Date | 2010-04-27 |
| Last Update Date | 2015-11-19 |