| NPI | 1609178409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP119702) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 720825) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2022-01-28 |