| NPI | 1841421666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9469925) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 669603) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2018-12-03 |