| NPI | 1134311400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP115928) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP115928) |
| 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: TX 654945) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2025-09-11 |