| NPI | 1275126948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1055723) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: TN 0000249155) |
| Enumeration Date | 2021-02-14 |
| Last Update Date | 2022-10-07 |