| NPI | 1669728903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP121823) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 667805) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2019-11-14 |