| NPI | 1043633225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP124936) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: TX 171026) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2018-05-02 |