| NPI | 1538559224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: TX AP120964) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP120964) |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2017-04-12 |