| NPI | 1306544986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1190672) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NM 72176) |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2025-04-22 |