| NPI | 1386003564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP134438) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK R0083276) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2020-07-14 |