| NPI | 1659803419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP133707) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX AP133707) |
| 363L00000X Nurse Practitioner (Licence: TX AP133707) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2020-04-07 |