| NPI | 1407328081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1227426) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 954060) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2026-04-09 |