| NPI | 1801557988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1117096) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11015053) |
| Enumeration Date | 2022-01-01 |
| Last Update Date | 2024-04-18 |