| NPI | 1851590681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 780890) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 3101372) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2010-09-22 |