| NPI | 1154728392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132162) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08078) |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2022-07-21 |