| NPI | 1144851494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP144733) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 842476) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2020-01-29 |