| NPI | 1639176266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP112358) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 238160) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2018-08-10 |