| NPI | 1508458605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1029742) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1029742) |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2021-02-09 |