| NPI | 1518520543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141406) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NH 092491-23) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2024-04-18 |