| NPI | 1801568647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1043918) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 68411) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2022-07-05 |