| NPI | 1437628666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP144202) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO APN.0994260) |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2023-06-29 |