| NPI | 1972208726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX F03230487) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX F03230487) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2024-11-06 |