| NPI | 1922434372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: FL ARNP9215294) |
| Additional Taxonomies | 363LW0102X Nurse Practitioner, Women's Health (Licence: TX 588788) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2016-07-01 |