| NPI | 1053540187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP123619) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA RN109960) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 835831) | |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2024-09-25 |