| NPI | 1316286776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP142306) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 9386243) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 22058) | |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2023-03-03 |