| NPI | 1043729502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP134031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 690207) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2021-06-21 |