| NPI | 1427370972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 820301) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP122001) |
| Enumeration Date | 2010-02-25 |
| Last Update Date | 2024-01-11 |