| NPI | 1669020756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP143346) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 847968) |
| Enumeration Date | 2019-08-31 |
| Last Update Date | 2022-01-27 |