| NPI | 1427721851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1047433) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 70509) |
| Enumeration Date | 2021-07-30 |
| Last Update Date | 2024-04-11 |