| NPI | 1508170705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP118786) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 562604) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2023-08-23 |