| NPI | 1871050880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138899) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 720019) |
| Enumeration Date | 2019-02-26 |
| Last Update Date | 2023-12-19 |