| NPI | 1134433113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP117709) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 666178) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2022-07-28 |