| NPI | 1962879445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NV 819041) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP128908) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP128908) | |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2024-05-02 |