| NPI | 1568702306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1018328) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 667062) |
| Enumeration Date | 2013-02-14 |
| Last Update Date | 2026-01-21 |