| NPI | 1972883791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP120969) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 701468) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2015-08-19 |