| NPI | 1962993006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NH 081474-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP137056) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2020-01-03 |