| NPI | 1245286079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP109590) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 618857) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2018-09-11 |