| NPI | 1609529700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1069133) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1069133) |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2024-12-17 |