| NPI | 1982722401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 620135) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 620135) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2014-06-04 |