| NPI | 1063797298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP120283) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 741383) |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2021-06-16 |