| NPI | 1952944399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 32087) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020259) |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2022-10-18 |