| NPI | 1336557032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126084) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11023629) |
| Enumeration Date | 2014-07-25 |
| Last Update Date | 2023-02-01 |