| NPI | 1780030981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1055990) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OK 103197) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2021-11-10 |