| NPI | 1992352660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP142044) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 209538) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA 209538) | |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2024-04-24 |