| NPI | 1598325649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141579) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: TX 837187) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2019-06-19 |