| NPI | 1518425149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX ap140689) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0992697-C-NP) |
| Enumeration Date | 2019-03-02 |
| Last Update Date | 2023-10-09 |