| NPI | 1508487398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP143471) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95014441) |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2021-11-19 |