| NPI | 1215278841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP120268) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP120268) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 0000110075) | |
| Enumeration Date | 2013-03-06 |
| Last Update Date | 2018-05-04 |