| NPI | 1326284514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 601953) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 202106694NP-PP) |
| Enumeration Date | 2008-12-18 |
| Last Update Date | 2021-11-08 |