| NPI | 1902850936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: VA 0024178958) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP113774) |
| 363LF0000X Nurse Practitioner Family (Licence: TX 637990) | |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2020-08-27 |