| NPI | 1649158981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7847331-4405) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 7847331-8900) |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2025-12-08 |