| NPI | 1891224648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP134094) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: TX AP124094) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2026-05-06 |