| NPI | 1831466820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX F0711381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 744983) |
| Enumeration Date | 2011-11-19 |
| Last Update Date | 2011-11-19 |