| NPI | 1922478890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 815341) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP129360) |
| 364SF0001X Clinical Nurse Specialist Family Health (Licence: TX AP129360) | |
| Enumeration Date | 2015-10-04 |
| Last Update Date | 2020-09-16 |