| NPI | 1326301946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP121943) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 745979) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2022-05-25 |