| NPI | 1518246818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP120535) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 509451) |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2016-03-17 |