| NPI | 1487761904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1023540) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX R0074337) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2024-02-14 |