| NPI | 1902317886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 135289) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 723702) |
| Enumeration Date | 2017-10-18 |
| Last Update Date | 2021-11-17 |