| NPI | 1407295058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP123272) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 718102) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2020-01-03 |