| NPI | 1427417468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1084113) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: TX 770391) |
| Enumeration Date | 2016-02-18 |
| Last Update Date | 2022-11-28 |