| NPI | 1740666569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP137246) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 827261) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2025-08-25 |