| NPI | 1568951044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP125745) |
| Additional Taxonomies | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: TX AP125745) |
| Enumeration Date | 2018-05-09 |
| Last Update Date | 2018-05-15 |