| NPI | 1669800546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP124663) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP124663) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 809797) | |
| Enumeration Date | 2013-10-31 |
| Last Update Date | 2020-06-26 |