| NPI | 1952715294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP139995) |
| Additional Taxonomies | 251J00000X Nursing Care |
| 332BN1400X Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209018630) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 6669) | |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2024-04-23 |