| NPI | 1043467145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP116948) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 648078) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2025-02-24 |