| NPI | 1821433236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP122638) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TX 751962) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2021-03-25 |