| NPI | 1578912325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP137445) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 340648) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP137445) | |
| Enumeration Date | 2016-06-11 |
| Last Update Date | 2022-01-07 |