| NPI | 1831594639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60673439) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126455) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2016-08-24 |