| NPI | 1225408792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP129135) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner Pediatrics (Licence: TX AP129135) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2024-08-07 |