| NPI | 1245638105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP126813) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126813) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2023-04-20 |