| NPI | 1629797428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1098289) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MS 905532) |
| Enumeration Date | 2022-08-24 |
| Last Update Date | 2024-03-20 |