| NPI | 1316738529 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1025249) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1025249) | 
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1025249) | |
| Enumeration Date | 2025-05-15 | 
| Last Update Date | 2025-10-20 |