| NPI | 1952856577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137111) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MA RN2291457) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP137111) | |
| Enumeration Date | 2016-08-24 |
| Last Update Date | 2022-11-21 |