| NPI | 1912404666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: LA AP09950) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP137216) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2018-07-25 |