| NPI | 1629498688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137255) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: TX 800096) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2020-06-30 |