| NPI | 1255889903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132457) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 102790) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2022-02-15 |