| NPI | 1871110627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145859) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 867077) |
| Enumeration Date | 2020-06-27 |
| Last Update Date | 2020-06-27 |