| NPI | 1588656649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP108928) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 653791) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2021-07-02 |