| NPI | 1720555097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP139481) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP139481) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2021-04-30 |