| NPI | 1629609987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144795) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AP144795) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2020-07-01 |