| NPI | 1477958049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126699) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP033376) |
| Enumeration Date | 2014-10-25 |
| Last Update Date | 2026-02-13 |