| NPI | 1568956456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11025441) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX AP137614) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11025441) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP137614) | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-09-11 |