| NPI | 1710236252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP122283) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 661453) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2021-04-29 |