| NPI | 1982834784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 118008) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 78849) |
| 363LF0000X Nurse Practitioner, Family (Licence: NE 116027) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP118008) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 326387) | |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2025-07-09 |