| NPI | 1558863068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP136590) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 854402) |
| Enumeration Date | 2018-03-01 |
| Last Update Date | 2024-04-26 |