| NPI | 1518814599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1228266) |
| Additional Taxonomies | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: TX 845279) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1228266) | |
| Enumeration Date | 2026-03-11 |
| Last Update Date | 2026-08-13 |