| NPI | 1326524125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP138297) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F07180615) |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2020-05-14 |