| NPI | 1811265952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 144797) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: OH 375009) |
| Enumeration Date | 2011-12-04 |
| Last Update Date | 2023-07-18 |