| NPI | 1295127306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126375) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA NP95001699) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2015-11-12 |