| NPI | 1720591159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX APRN135760) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP135760) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2020-12-21 |