| NPI | 1124578455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP131226) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP131226) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX AP131226) | |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2020-10-22 |