| NPI | 1932723541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP141902) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: TX 860434) |
| Enumeration Date | 2020-05-31 |
| Last Update Date | 2020-05-31 |