| NPI | 1346787736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP145412) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-140150) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2020-06-09 |