| NPI | 1053070284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1044623) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1044623) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2026-02-05 |