| NPI | 1669136792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1060367) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA F10211027) |
| Enumeration Date | 2021-10-25 |
| Last Update Date | 2021-12-24 |