| NPI | 1992254809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP140305) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN128464) |
| 363L00000X Nurse Practitioner (Licence: TX AP140305) | |
| 363LF0000X Nurse Practitioner, Family (Licence: LA AP09086) | |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2024-09-09 |