| NPI | 1750996534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP1028619) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 792196) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2021-02-25 |