| NPI | 1710328497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP124045) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 654923) |
| Enumeration Date | 2013-07-10 |
| Last Update Date | 2015-04-27 |