| NPI | 1134650161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP133633) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX 846965) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-05-30 |