| NPI | 1144417106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP132012) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2021-10-18 |