| NPI | 1003935032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 676839) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 676839) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: TX 676839) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2021-06-22 |