| NPI | 1699440008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP146137) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP146137) |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2023-01-11 |