| NPI | 1295138816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP126277) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP126277) |
| Enumeration Date | 2014-09-28 |
| Last Update Date | 2022-06-16 |