| NPI | 1952819468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137114) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9365004) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2021-03-18 |