| NPI | 1629440599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5010981) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP129522) |
| Enumeration Date | 2015-10-30 |
| Last Update Date | 2021-02-25 |