| NPI | 1619526761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP143345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 863924) |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2021-04-08 |