| NPI | 1164736120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 739803) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 739803) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2013-05-21 |