| NPI | 1548769052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX F02180337) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX F02180337) |
| Enumeration Date | 2018-02-10 |
| Last Update Date | 2020-03-02 |