| NPI | 1962455451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP145756) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN11551) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2020-06-11 |