| NPI | 1255938866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX 1016138) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM cs02328871) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2026-07-09 |