| NPI | 1598332207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1043661) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX 1043661) |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-12-23 |