| NPI | 1568865889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 779333) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02550) |
| Enumeration Date | 2014-10-01 |
| Last Update Date | 2024-11-12 |