| NPI | 1942422597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 718439) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 718439) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2024-05-02 |