| NPI | 1689341281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1066766) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: UT 86375054405) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2022-04-20 |