| NPI | 1437541331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127306) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 257185) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2015-07-16 |