| NPI | 1447655774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP126782) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX APN126782) |
| 363L00000X Nurse Practitioner (Licence: TX 806114) | |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2020-08-07 |