| NPI | 1982027280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP133271) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2013043629) |
| Enumeration Date | 2014-01-23 |
| Last Update Date | 2021-09-10 |