| NPI | 1750081816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX 1020270) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 1020270) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2025-09-13 |