| NPI | 1033480520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP121125) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 698372) |
| Enumeration Date | 2012-01-16 |
| Last Update Date | 2014-11-21 |