| NPI | 1528624632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141033) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 28243) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 22843) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2022-07-13 |