| NPI | 1225691736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141386) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 235375) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2025-08-07 |