| NPI | 1881821692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP117969) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 677578) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 677578) | |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2021-07-13 |