| NPI | 1417588393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP142962) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AR 123345) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2022-11-09 |