| NPI | 1104327998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135352) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10987) |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2024-05-20 |