| NPI | 1437884731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1125715) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 10444493-4405) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2023-11-08 |