| NPI | 1457098873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1139009) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 944358) |
| 363L00000X Nurse Practitioner (Licence: TX 1139009) | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2024-08-16 |