| NPI | 1356733356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP127493) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP127493) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP127493) | |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2022-08-30 |