| NPI | 1235561663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP123816) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 760471) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2017-05-10 |