| NPI | 1326548108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1129701) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 919984) |
| Enumeration Date | 2018-02-18 |
| Last Update Date | 2024-03-19 |