| NPI | 1336623115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1045186) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: TX 954203) |
| 363L00000X Nurse Practitioner (Licence: TX 1045186) | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2024-09-04 |