| NPI | 1689708794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144925) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 637774) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2022-07-13 |