| NPI | 1134604457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP139031) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139031) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2024-09-28 |