| NPI | 1346801057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP141985) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP141985) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2025-01-16 |