| NPI | 1225157456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP108856) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 654118) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2015-05-15 |