| NPI | 1649781220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP135549) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 295794) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2023-08-16 |