| NPI | 1649735143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139812) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 828949) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2024-09-16 |