| NPI | 1265932230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1112053) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 921743) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2024-05-30 |