| NPI | 1457712549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130570) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 55685) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2019-09-10 |