| NPI | 1528203155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 670631) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5004212) |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2021-10-06 |