| NPI | 1225363906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127005) |
| Additional Taxonomies | 251E00000X Home Health (Licence: TX 010877) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2019-11-23 |