| NPI | 1437848744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1066299) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 1614) |
| Enumeration Date | 2023-05-03 |
| Last Update Date | 2024-08-01 |