| NPI | 1457995052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1010020) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 814698) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2023-12-22 |