| NPI | 1457877151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP134217) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP134217) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP134217) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2025-04-29 |