| NPI | 1245734011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP137183) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX F02180599) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2019-09-05 |