| NPI | 1164907457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138226) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AP138226) |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 858460) | |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2023-10-26 |