| NPI | 1174896575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP121548) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 675625) |
| Enumeration Date | 2012-02-15 |
| Last Update Date | 2021-02-24 |