| NPI | 1811147820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP124217) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO 5869) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2015-09-28 |