| NPI | 1215642269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1110502) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F01230562) |
| Enumeration Date | 2023-01-13 |
| Last Update Date | 2023-03-02 |