| NPI | 1528367885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1075931) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN117053) |
| 363L00000X Nurse Practitioner (Licence: LA AP06612) | |
| Enumeration Date | 2011-03-24 |
| Last Update Date | 2024-04-19 |