| NPI | 1316428980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1020795) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 879111) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60892216) | |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2021-05-05 |