| NPI | 1679033476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP141070) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 848612) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-02-05 |