| NPI | 1114730173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1183724) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11043436) |
| 163W00000X Registered Nurse (Licence: TX 1183724) | |
| 163W00000X Registered Nurse (Licence: NY 834513) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 359013) | |
| Enumeration Date | 2025-01-31 |
| Last Update Date | 2026-04-23 |