| NPI | 1043780513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL f11180340) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP142189) |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2024-09-16 |