| NPI | 1912476102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139184) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 54500) |
| Enumeration Date | 2018-11-16 |
| Last Update Date | 2018-11-16 |