| NPI | 1417730425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1183614) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0100914-C-NP) |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2025-05-20 |