| NPI | 1790186484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NH 075358-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP126443) |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2018-03-17 |