| NPI | 1730597659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125826) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209012875) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2025-07-23 |