| NPI | 1235771874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP143503) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: OR 201911388NP-PP) |
| Enumeration Date | 2019-10-15 |
| Last Update Date | 2022-04-12 |