| NPI | 1386695377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130899) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP008998) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2020-11-16 |