| NPI | 1093231631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135444) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: TX 758325) |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2022-05-10 |