| NPI | 1164885133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130529) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2024-07-04 |