| NPI | 1750926739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP143943) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 803416) |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2025-08-21 |