| NPI | 1841796562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP136933) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX AP136911) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2024-01-22 |