| NPI | 1477944718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP127439) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NY 357889) |
| Enumeration Date | 2015-02-09 |
| Last Update Date | 2026-04-07 |