| NPI | 1568233351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1154417) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 946501) |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-04-11 |