| NPI | 1316310725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1109017) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3009880) |
| Enumeration Date | 2015-11-06 |
| Last Update Date | 2023-08-22 |