| NPI | 1891884649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 693051) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP119552) |
| 363L00000X Nurse Practitioner (Licence: LA 102750) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-06-23 |