| NPI | 1003448416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144057) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX AP144057) |
| Enumeration Date | 2020-02-04 |
| Last Update Date | 2023-03-28 |