| NPI | 1992935365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 719954) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TX 719954) |
| 163WC0400X Registered Nurse, Case Management (Licence: TX 719954) | |
| 163WH0200X Registered Nurse, Home Health (Licence: TX 719954) | |
| 363L00000X Nurse Practitioner (Licence: TX 719954) | |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2012-10-17 |