| NPI | 1124896295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1130771) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 1130771) |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2024-03-26 |