| NPI | 1902405814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145444) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 804532) |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2020-10-21 |