| NPI | 1285152769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135503) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F09170006) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2017-10-17 |