| NPI | 1578931382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP128916) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: TX AP128916) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2023-04-18 |