| NPI | 1235889882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1089194) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: TX 843783) |
| Enumeration Date | 2022-03-26 |
| Last Update Date | 2022-11-27 |