| NPI | 1629295480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP112028) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 583408) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2021-09-10 |