| NPI | 1902164023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP122042) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 661542) |
| Enumeration Date | 2012-04-26 |
| Last Update Date | 2021-02-10 |