| NPI | 1912474479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139501) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 838821) |
| Enumeration Date | 2018-11-01 |
| Last Update Date | 2021-12-15 |