| NPI | 1669923108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP132545) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 749252) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-11-08 |