| NPI | 1922055292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 603165) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 603165) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2008-07-15 |