| NPI | 1760767156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 696959) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP119021) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2022-04-21 |