| NPI | 1255945200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1070301) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95014922) |
| Enumeration Date | 2020-09-06 |
| Last Update Date | 2023-12-20 |