| NPI | 1649815978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144538) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 2019055884) |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2024-09-09 |