| NPI | 1366889206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP123763) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 750341) |
| Enumeration Date | 2013-06-02 |
| Last Update Date | 2015-06-30 |