| NPI | 1639735293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP141494) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 141494) |
| Enumeration Date | 2019-05-18 |
| Last Update Date | 2019-08-21 |