| NPI | 1043729502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TX AP134031) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5017452) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: NC 5017452) | |
| 163W00000X Registered Nurse (Licence: TX 690207) | |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2025-10-06 |