| NPI | 1639613508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132763) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 803805) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2017-01-12 |