| NPI | 1992374417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1034642) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1034642) |
| Enumeration Date | 2021-06-19 |
| Last Update Date | 2024-07-25 |