| NPI | 1447752852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP136837) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AP136837) |
| 208000000X Pediatrics (Licence: TX AP136837) | |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2018-03-17 |