| NPI | 1326574773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP133922) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: TX AP133922) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP133922) | |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-04-29 |