| NPI | 1588118194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131483) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 812762) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2022-06-08 |