| NPI | 1669857082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP129030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 814306) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP129030) | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2023-04-18 |