| NPI | 1073184131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1037458) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 260349) |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2023-12-08 |