| NPI | 1134262355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP115041) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 648037) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2014-05-22 |