| NPI | 1013580240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1060750) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 853775) |
| Enumeration Date | 2021-07-24 |
| Last Update Date | 2022-06-01 |