| NPI | 1508947151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP113414) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: TX 654491) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2023-02-20 |