| NPI | 1144001611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1138829) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 886999) |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2025-03-14 |