| NPI | 1750322913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP110995) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 601407) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-11-03 |