| NPI | 1417384470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP131345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 00169785) |
| 163W00000X Registered Nurse (Licence: TX 899927) | |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2024-04-03 |