| NPI | 1952774523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP129160) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: TX AP129160) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2023-07-24 |