| NPI | 1538412275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP122580) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 607702) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2022-01-08 |