| NPI | 1023216389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP116800) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 739810) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2017-05-10 |