| NPI | 1205477874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144044) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F09191673) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2022-07-15 |