| NPI | 1982603833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 664465) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP109980) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-04-24 |