| NPI | 1033416284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1039299) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: TX SA00448) |
| 363L00000X Nurse Practitioner (Licence: FL 11012909) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1039299) | |
| Enumeration Date | 2011-02-24 |
| Last Update Date | 2024-01-21 |