| NPI | 1235644352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP136399) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP136399) |
| 363LP0200X Nurse Practitioner Pediatrics (Licence: TX 844877) | |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2021-04-20 |