| NPI | 1053565689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 712851) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 712851) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2019-11-06 |