| NPI | 1285101626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP137412) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: LA AP09760) |
| Enumeration Date | 2018-10-24 |
| Last Update Date | 2020-11-25 |