| NPI | 1518436252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP140030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 801295) |
| Enumeration Date | 2018-11-23 |
| Last Update Date | 2025-01-20 |