| NPI | 1942331244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 361356-4405) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 747921) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2016-02-09 |