| NPI | 1558874198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP135643) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135643) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2023-07-07 |