| NPI | 1396002937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP121137) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 761088) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2018-03-02 |