| NPI | 1679821292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP122275) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 754877) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2014-12-05 |