| NPI | 1619123726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX Ap117607) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 577699) |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP01504) | |
| Enumeration Date | 2008-08-09 |
| Last Update Date | 2022-05-09 |