| NPI | 1629417217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1042286) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: LA AP07347) |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2021-08-06 |