| NPI | 1275923286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-03283) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127333) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP127333) | |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2018-12-26 |