| NPI | 1619302338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP136861) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 842472) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2022-10-04 |