| NPI | 1093240590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP131758) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 905466) |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2017-04-22 |