| NPI | 1609432764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141138) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AP141138) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP141138) | |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2020-09-24 |