| NPI | 1326523499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 213517) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1180869) |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2026-07-31 |