| NPI | 1447791850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP135326) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 930060) |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2022-03-14 |