| NPI | 1487991998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 816882) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP122909A) |
| Enumeration Date | 2013-01-04 |
| Last Update Date | 2024-07-29 |