| NPI | 1588055420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP127272) |
| Additional Taxonomies | 282NC0060X General Acute Care Hospital, Critical Access (Licence: TX AP127272) |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2017-02-24 |