| NPI | 1376573907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP124274) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 654368) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 654368) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2014-10-30 |