| NPI | 1992367312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QB0002X Family Medicine, Bariatric Medicine (Licence: TX AP142487) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95023942) |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2023-04-07 |