| NPI | 1922470335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP129185) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 2015009023) |
| Enumeration Date | 2015-10-24 |
| Last Update Date | 2016-06-09 |