| NPI | 1205349123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP134391) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 741564) |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2017-11-14 |