| NPI | 1003258856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP124077) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 717755) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2023-05-10 |