| NPI | 1356016273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP1046790) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046790) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2022-06-22 |