| NPI | 1942088570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1136489) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95032835) |
| Enumeration Date | 2023-09-15 |
| Last Update Date | 2025-03-13 |