| NPI | 1356636476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1017352) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 643013) |
| Enumeration Date | 2011-06-16 |
| Last Update Date | 2022-10-15 |