| NPI | 1851663421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IA A135664) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 16434) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP124908) | |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2022-11-08 |