| NPI | 1417221946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1116832) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: TX 964788) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2023-08-09 |