| NPI | 1821422791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125460) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 695603) |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2018-07-30 |