| NPI | 1124624721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046797) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 4017347) |
| 163WE0003X Registered Nurse, Emergency (Licence: TX 826375) | |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2024-04-04 |