| NPI | 1487298519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 860569) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 134599) |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2021-08-16 |