| NPI | 1043715535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1029370) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 342792) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2024-07-11 |