| NPI | 1700063278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: TX AP121818) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: LA AP04809) |
| 363LX0106X Nurse Practitioner, Occupational Health (Licence: LA AP04809) | |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2025-03-31 |