| NPI | 1568136075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1060018) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL 11014403) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11014403) | |
| Enumeration Date | 2021-08-07 |
| Last Update Date | 2022-06-23 |