| NPI | 1811486228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP61288019) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137759) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX F04180510) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61288019) | |
| Enumeration Date | 2018-05-02 |
| Last Update Date | 2024-11-18 |