| NPI | 1285108837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP140206) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 55576) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2020-07-13 |