| NPI | 1285091256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP131614) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA 08612) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP131614) | |
| Enumeration Date | 2016-01-21 |
| Last Update Date | 2018-03-29 |