| NPI | 1548612807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131491) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 747619) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2021-12-08 |