| NPI | 1396247292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP136885) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 881960) |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2019-05-22 |