| NPI | 1811132970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP117625) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 677949) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2017-04-11 |