| NPI | 1477945384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP127617) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP08179) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP127617) | |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2020-04-29 |