| NPI | 1134171580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP111484) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT RN28726) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2022-07-27 |