| NPI | 1285200097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1178692) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: TX 320322) |
| 163WH1000X Registered Nurse, Hospice (Licence: TX 881431) | |
| Enumeration Date | 2021-06-02 |
| Last Update Date | 2024-10-24 |