| NPI | 1114076882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP112515) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 655208) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2019-06-27 |