| NPI | 1245696236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP129878) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 831772) |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2017-01-02 |