| NPI | 1164869103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP123675) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 743390) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2022-07-22 |