| NPI | 1962633974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP125503) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 723898) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP125503) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2015-10-20 |