| NPI | 1326548207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1035653) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 890421) |
| Enumeration Date | 2018-02-16 |
| Last Update Date | 2022-05-29 |