| NPI | 1427685932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX F03200185) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP145906) |
| Enumeration Date | 2020-03-25 |
| Last Update Date | 2024-12-16 |