| NPI | 1821106964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX F0706310) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F0706310) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2014-03-31 |