| NPI | 1528449626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP128329) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 766565) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP128329) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2023-04-29 |