| NPI | 1255879300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP133157) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 814311) |
| 363L00000X Nurse Practitioner (Licence: TX 814311) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2021-06-10 |