| NPI | 1861772634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1692) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AR 217347) |
| Enumeration Date | 2011-08-24 |
| Last Update Date | 2022-01-31 |