| NPI | 1194281949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1094962) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 902420) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2025-12-28 |