| NPI | 1922640879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP142461) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP142461) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 838431) | |
| Enumeration Date | 2019-10-11 |
| Last Update Date | 2023-02-08 |