| NPI | 1588110985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131854) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CO C-APN.0001142-C-NP) |
| Enumeration Date | 2016-08-27 |
| Last Update Date | 2019-11-20 |