| NPI | 1356836639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141349) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 59019) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2023-07-31 |