| NPI | 1487302907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1073980) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX Temp) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-01-25 |