| NPI | 1013564129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP142231) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 833956) |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2021-07-26 |