| NPI | 1689720385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 794822) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ND R25438) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2018-07-24 |