| NPI | 1215467980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP134493) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 841615) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2023-02-28 |