| NPI | 1679175475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX APRN1027787) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11010060) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2021-06-24 |