| NPI | 1588463137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1035926) |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2025-03-07 |
| Last Update Date | 2025-08-22 |