| NPI | 1528541489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138718) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 736743) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2025-09-29 |