| NPI | 1437820677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1151771) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SD R049454) |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95027936) | |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2024-02-06 |