| NPI | 1225494800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130428) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-03250) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 0000166726) | |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2023-12-05 |