| NPI | 1124251103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX F1009375 NP-C) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX RN 794786) |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2024-01-11 |