| NPI | 1730926015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1247300) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: TX 801588) |
| Enumeration Date | 2024-07-12 |
| Last Update Date | 2026-08-30 |