| NPI | 1770922403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP121142) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 723176) |
| Enumeration Date | 2013-06-16 |
| Last Update Date | 2024-07-21 |