| NPI | 1417500471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP142966) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 752432) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2020-02-16 |