| NPI | 1952742223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125294) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX F0613254) |
| Enumeration Date | 2013-07-15 |
| Last Update Date | 2022-05-11 |