| NPI | 1023590023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX TXAP137772) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX TXAP137772) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX TXAP137772) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX TXAP137772) | |
| Enumeration Date | 2018-09-05 |
| Last Update Date | 2021-09-08 |