| NPI | 1922437706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP124581) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: TX AP124581) |
| 363L00000X Nurse Practitioner (Licence: TX AP124581) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 726423) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP124581) | |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2022-03-28 |