| NPI | 1891254819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP140684) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 841127) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2022-08-09 |