| NPI | 1518510726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141921) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11022426) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2024-06-18 |