| NPI | 1194809657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SF0001X Clinical Nurse Specialist, Family Health (Licence: TX 636969) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: TX 636969) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2014-11-04 |