| NPI | 1518597350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1000597) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013646) |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-11-23 |