| NPI | 1093224081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137802) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN218638) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP137802) | |
| Enumeration Date | 2017-09-22 |
| Last Update Date | 2025-04-29 |