| NPI | 1962985606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NM 85486) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP135105) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2025-09-02 |