| NPI | 1720529910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP136791) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OK 101563) |
| 363LF0000X Nurse Practitioner, Family (Licence: OK F09170912) | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2024-01-16 |