| NPI | 1326312026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP122022) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 777567) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2020-05-21 |