| NPI | 1205968401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP112647) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 651762) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2021-01-06 |