| NPI | 1326635145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1018947) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: ID 2181213) |
| Enumeration Date | 2020-12-28 |
| Last Update Date | 2026-05-26 |