| NPI | 1912290362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP120784) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 783920) |
| Enumeration Date | 2011-05-18 |
| Last Update Date | 2020-06-02 |