| NPI | 1518499672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP133681) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX AP133681) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2022-07-21 |