| NPI | 1912229154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP118938) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 662459) |
| Enumeration Date | 2010-02-15 |
| Last Update Date | 2020-05-21 |