| NPI | 1609535129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1057764) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 844152) |
| Enumeration Date | 2021-12-13 |
| Last Update Date | 2026-04-07 |