| NPI | 1659548402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 596797) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP116819) |
| Enumeration Date | 2008-05-12 |
| Last Update Date | 2023-08-01 |