| NPI | 1154816098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AR 124193) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137814) |
| Enumeration Date | 2018-06-23 |
| Last Update Date | 2020-07-13 |