| NPI | 1871901736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP126060) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126060) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2017-06-06 |