| NPI | 1699913780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 610787) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP117107) |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2023-12-11 |