| NPI | 1396399416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145963) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 920254) |
| Enumeration Date | 2019-07-26 |
| Last Update Date | 2022-05-12 |