| NPI | 1932559929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1089057) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 10869057) |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2022-11-10 |