| NPI | 1609281591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125603) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 669176) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2025-02-12 |