| NPI | 1346625779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX F0715263) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP128776) |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2022-12-05 |