| NPI | 1033777545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145096) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-78771-101) |
| Enumeration Date | 2019-05-30 |
| Last Update Date | 2024-09-20 |