| NPI | 1912450628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 131597) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX 131597) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 131597) | |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2026-04-21 |