| NPI | 1558650226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1003131) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: TX 1003131) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2023-03-21 |