| NPI | 1356526586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 649231) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 649231) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 649231) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2023-10-09 |