| NPI | 1922435759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 800688) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 855867) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 78417) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IA A169406) | |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2024-05-07 |