| NPI | 1952918690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1096902) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 935793) |
| Enumeration Date | 2020-09-27 |
| Last Update Date | 2026-07-21 |