| NPI | 1700213220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP133114) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP133114) |
| Enumeration Date | 2013-09-29 |
| Last Update Date | 2022-11-15 |