| NPI | 1275353831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1180325) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: TX 832972) |
| Enumeration Date | 2024-10-16 |
| Last Update Date | 2024-11-21 |