| NPI | 1073905709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127622) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 111115) |
| Enumeration Date | 2015-03-04 |
| Last Update Date | 2015-10-13 |