| NPI | 1932106994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 658055) |
| Additional Taxonomies | 251B00000X Case Management |
| 363LF0000X Nurse Practitioner, Family (Licence: NM R27256) | |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2024-04-24 |