| NPI | 1376114132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1046533) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1046533) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1046533) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: TX 1046533) | |
| Enumeration Date | 2021-07-02 |
| Last Update Date | 2025-07-07 |