| NPI | 1598135832 |
|---|---|
| Former Name | MICHAEL SHANE SMITH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP129170) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP129170) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2023-01-13 |