| NPI | 1841725629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP133870) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 832250) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2019-03-11 |