| NPI | 1285986695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP122749) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 769865) |
| Enumeration Date | 2012-10-09 |
| Last Update Date | 2024-05-20 |