| NPI | 1326925090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL APRN11033649) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1046941) |
| 207Q00000X Family Medicine (Licence: KY 4045371) | |
| Enumeration Date | 2025-08-16 |
| Last Update Date | 2025-08-16 |