| NPI | 1851999817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1016216) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2024-11-18 |