| NPI | 1942826904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1000941) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 60435) |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2020-09-05 |